This is Steven Salzberg's blog on genomics, pseudoscience, medical breakthroughs, higher education, and other topics, including skepticism about unscientific medical practices. Here's where I can say what I really think about abuses and distortions of science, wherever I see them.

The worst quackery of 2011: battlefield acupuncture

Pseudoscience continued to thrive in 2011, making my choice for the worst quackery of the year a difficult one. So much nonsense! Promoters of both new age and old-time hocus pocus continued to sell their unscientific therapies, as they have for decades (or centuries), including homeopathy, Ayurveda, acupuncture, qigong, reiki, magnet therapy, and a cornucopia of special "super foods", all guaranteed to cure whatever ails you. These various alternatives to medicine are just as ridiculous today as when they were invented, decades or centuries ago.

How can anyone choose the worst practice among so many false claims? Well, those that cause real harm to patients are worse than those that are merely useless. I also decided to give extra weight to newer forms of mumbo jumbo. But I could have chosen differently, and I encourage readers to nominate their own favorites in the Comments section.

And the 2011 winner of the worst quackery award is: battlefield acupuncture. This particular bizarre medical practice offers a trifecta of ills:

It offers no medical benefit and carries a real risk of harm for some patients.

The U.S. government is wasting tens of millions of dollars per year on it, and plans to increase its spending next year.

The patients are wounded combat veterans who have no choice about where to get treatment.

Battlefield acupuncture has a growing number of supporters in the U.S. Defense Department (especially Richard Niemtzow, its proud inventor), who are determined to see it delivered to as many troops as possible. I've written about this before, but it's in the news again this month, in Wired magazine. In battlefield acupuncture, the "doctor" (no competent doctor would do this) sticks needles into the patient's ear to relieve pain. Yes, that's right: needles in the ear.

Battlefield acupuncture was invented out of whole cloth by military doctor Richard Niemtzow, who runs an acupuncture clinic out of Andrews Air Force Base in Maryland. Niemtzow appears to be the leading advocate for the use of acupuncture on wounded soldiers, and he has been disturbingly effective. The military publication Stars and Stripesreported in August that the Air Force has

"launched a program to train more than 30 military doctors to use acupuncture in the war zone and at their base clinics. The program will be expanded next year with the Air Force, Army and Navy combining funds for two courses to certify 60 active-duty physicians as medical acupuncturists."

Multiple scientific studies have shown clearly that acupuncture doesn't work. The benefit is the same no matter where you place the needles, or even if you use toothpicks that don't pierce the skin. (See a summary here, with multiple references.) Acupuncture points and "meridians" - the pathways that acupuncturists claim to manipulate with their needles - don't even exist.

Acupuncture carries a real risk of harm, too, primarily from infection. Acupuncturists don't practice sterile procedure, as I've pointed out before. They claim that they do, because they think that using sterilized needles is sufficient. Wrong again. Sterile procedure requires that every site of needle insertion be properly sterilized, because most infections are caused by bacteria already present on the skin. As reported last year in BMJ:

"Although most patients recovered, 5-10% died of the infections and at least another 10% had serious consequences such as joint destruction, paraplegia, necrotising fasciitis, and multiorgan failure."

Pretty serious harm from a procedure with no real benefit.

The evidence for "auricular acupuncture" - sticking needles in the ear - is less than zero. This shouldn't be surprising, since Neimtzow just pulled this wacky theory out of thin air - but he and his converts have repeatedly asserted that it works, although they offer nothing more than anecdotes. Niemtzow has even claimed that 18th-century pirates pierced their ears to improve their night vision. Yes, really. Now he's piercing the ears of wounded soldiers.

But the real harm is in treating wounded soldiers by sticking needles in their ears, instead of offering real treatments. To their credit, some soldiers are not fooled by Niemtzow's claims. As a veteran over at Military.com said,

"In civilian medicine, this [battlefield acupuncture] would be called malpractice. This smacks of using military personnel in the field as guinea pigs. That's a dangerous game. If the pain of severe trauma isn't treated effectively in a timely manner, shock and even death can follow."

That discussion appeared in 2008, but three years later, Andrews Air Force Base has a full-time acupuncture clinic, and the military is training more doctors in this dangerous, ineffective, and highly unethical practice. For this, battlefield acupuncture gets my award for the worst quackery of 2011.

11 comments:

I totally agree with you but just would clarify that the needles don’t go IN the ear, per se, but in the earlobe--I had this done many years ago when I toyed with some of these altie things. I have to confess that I swore by it at the time--not for curing anything, but because it seemed that the needles in the earlobes made me very HIGH. I remember not feeling able to drive home for about half an hour after the “treatment” (which was for tennis elbow, by the way). It’s funny that I thought it worked at the time, but now I realize that I was also taking NSAID’s for something else at the time and that is probably much more likely what helped the tendinitis. I fell for all the mumbo jumbo I read so much about now. I still can’t explain the “high” from the acupunture, but the doctor (a Chinese MD who had discovered that in Oregon, insurance would pay for acupuncture done by an MD), said it was a common “side effect” of the “treatment”. He wore a white coat and had a big “meridian” chart, but did NOT use sterile technique. I now shudder at the thought of all this and shudder even more at the idea of this crap being used on an actual battlefield!

Luise: I don't know if you are an acupuncturist, but your comment reflects a common claim of the acupuncture industry. The problem is that sterile needles are not nearly enough. Any good infectious disease doctor knows that most of the bacteria that cause infections reside on our skin - everyone has bacteria all over their skin. This is why the site of a shot (a vaccine, for example) needs to be sterilized with alcohol first. Every acupuncture site would have to be sterilized - every patch of skin - in a proper infection control protocol.

After 13 years practicing Chinese Medicine and 11 as an instructor, I have seen thousands of patients come and go.Number of infections due to acupuncture: NONENumber of infections due to simply entering a hospital per year: 1.7 million according to the CDC. This does does not even include infections caused by surgery which is one of the top causes of death alongside errors in medication dosing and bleed outs.As for alcohol, certainly not 100% effective due to its rapid evaporation time. This said, every licensed acupuncturist in the USA has been certified in Clean Needle Technique to decrease infection risk. From this vantage point, this practice is adequately effective.I'd appreciate a study on the competency of personnel in charge of sterilizing surgical instruments. I would venture to say that the data would be somewhat unsettling.According to an article ran in The Guardian (March 2010), 86 people have died due to acupuncture in the world over the last 45 years.Number of avoidable hospital deaths in the US per year: the CDC states approximately 100,000 deaths and an estimated $20 billion in healthcare costs.

Dennis- your reply is filled with non-sequiturs and a false logic. First, people should know that acupuncturists are not required to report infections and adverse events, and generally don't. So your claims are just an anecdote from your own personal experience. We just don't have real data. Second, real medicine offers (in many cases) demonstrable benefits, while acupuncture does not. So yes, there are risks to real medical procedures, and mistakes are made sometimes. But at least there is a chance of benefit. Not true with acupuncture.

Yes Steven, I believe I took ownership of my personal experience of never seeing an infection caused by acupuncture over 13 years of private practice and 10 years supervising interns in community clinic settings. Not a minute sampling.

As for "sometimes" make mistakes, The HealthGrades Patient Safety in American Hospitals study, released in 2010, puts the death toll at 534 per day nationwide. That's 195,000 dead people per year due to preventable in-hospital errors. I'm not even going to go into the number of infections and disabilities per year.

As for the efficacy, Steven, your dismissal is unfortunate because the following is a list of some organizations who endorse and utilize acupuncture because they they have found it to be a viable and effective treatment:

The NIH and the NCCAM, both branches of US Department of Health and Human Services. This from the director, Josephine Briggs: "... acupuncture affects structures of the limbic system involved in the affective/suffering components of pain. Neurochemical studies are revealing the effects of acupuncture on neurotransmitters such as noradrenaline and endogenous opioid peptides that are associated with descending endogenous pain-modulating systems. Other neurochemical studies are exploring whether acupuncture increases nonenzymatic nitric oxide generation and the role that may play in acupuncture effects, such as inducing noradrenaline release.

Clinical research is also keeping pace. A systematic review of randomized controlled clinical trials of acupuncture for postoperative pain, published in the August 2008 issue of the British Journal of Anaesthesia, demonstrated that acupuncture had clear value, that it decreased pain intensity and lowered opioid side effects. Recently, the American Pain Society and the American College of Physicians published new clinical treatment guidelines for persistent back pain that now include acupuncture as a treatment option."

Major League Baseballhttp://ajw.asahi.com/article/behind_news/people/AJ201211010081

This list is quite incomplete. But the point being, Steven, is, as ancient as acupuncture is, your line of thinking here is even more antiquated and behind the curve. I would suggest taking a harder look at that.

Dennis, your insistence that your personal experience trumps scientific evidence indicates that you don't seem to understand the nature of scientific methodology. You can claim all you like about your personal experience, but it is uncontrolled, anecdotal, and biased - and it does not support scientific claims. Then you continue to misunderstand - deeply - your mis-use of statistics about hospital deaths. People go to hospitals for life-threatening conditions, and sometimes they die. I can't believe that you seriously think you could show up, administer acupuncture, and save all those lives. It's just a non-sequitur to compare hospital deaths across all causes to acupuncture. Then you quote NCCAM's director - well, if you search NCCAM on this blog you will see that I've written about it many, many times, and done extensive research into NCCAM's promotion of quackery and nonsense. I and others have looked at the studies that claim acupuncture works better than placebo, and found those studies seriously flawed. Many other, better studies have shown that acupuncture simply doesn't work. If it weren't for all the money that you and others were making by offering this ineffective therapy, it would have been abandoned long ago. But you and others continue to promote it because you have a personal incentive to do so. That's too bad for the patients who spend their hard-earned money on it.